Bone Pathology Database

Teaching Version

Text in Italics is general (instructional) information

Magnetic Resonance Image

Axial Magnetic resonance image

Operatrive photograph

The straight x rays on the previous page show collapse of T12 vertebra. The same process affects the T11 vertebra. The vertebra appears sclerotic. The MRI images show multiple cysts in the body of T12 as well as T11 and L1. The cysts are more numerous in the posterior portion of the vertebra and impinge on, and compress the spinal cord.Because adjacent vertebrae are involved the didfferential is basically that of an infective process. Tuberculosis or a paracytic process such as hydatid disease are possibilities.Tuberculosis is a more lytic process and there is little soft tissue swelling present. The multiple cysts suggest the daughter cysts of echonococcus A posterior decompression was done and the paracytic material was debrided.
In hydatid infestations of bone, it is often possible only to control, but
not to eliminate the cysts. The diseased bone must be treated with the same principles
as malignant tumor surgery. The only hope of cure is by total excision with a
wide margin. If this is not possible the treatment is aimed at controlling the
lesion Supplemental medical therapy with benzoimidazole carbamates (mebendazole
and albendazole) is recommended and was given in this patient.The drug has hepato-renal
toxicity. Liver, kidney, and hemopoietic function tests need to be carried out
every 10 to 15 days during treatment
Wide excision or curettage is recommended The application of concentrated saline
(30%) to irrigate the cysts is effective, but could not be used in this case due
to proximity to the spinal cord.
The cyst infested bone is excised with a wide margin of healthy bone. Black surgical
drapes are recommended to make the light coloured scolices more visible.